Trauma Healing for Haitian Nursing Students
A hundred nursing students come to our hotel. More than ninety of their classmates died on January 12th in their school building. The sense of sadness and loss are palpable.
They are quiet, expectant, and perhaps a little puzzled at first. What is this “mind-body medicine” all about? And then, as I begin to talk with them about fight-or-flight and stress, they become animated—calling up the unspeakable terror of the earthquake along with the biological facts and personal experience. I explain that just as trauma can produce the symptoms of ongoing stress: difficulty concentrating, sleeplessness, anger, lethargy, flashbacks of death and destruction. The techniques we are going to teach—slow deep breathing, self-expression and self-discovery in drawings, sharing one’s pain and hopes with others, and moving one’s body—can give relief; restore a sense of calmness, provide perspective, grant them a sense of control, open the door to the possibility of a future.
By the time Amy is explaining imagery and Kathy and Lynda are encouraging them in their drawings, the young women are alive with pleasure and discovery. They share first with each other, and then with the whole group. They show us pictures bisected by the barriers between the living and the dead, whom they miss so much, and third drawings that reveal the possibility of feeling, though bereaved, whole again in nature and with family and friends.
By the time we clear away the chairs and began to shake, the girls are waving their arms and laughing. When Bob Marley’s “Three Little Birds (Every Little Thing’s Gunna Be Alright)” comes on, they sing with him, and us. Some of us are still laughing, others crying in release, with gratitude as well as grief.
Afterwards, the Dean of the Nursing School speaks for a moment. “Words,” she says, herself crying, “cannot express what you have done for us today.”
“And,” I think to myself, “what you are doing and teaching to us.”
At School in Haiti: Andre's Story
At the end of the third class, a quiet, solemn boy asks if he can speak with me. “What,” he had wondered during class, “about memories of the lost person that come back again and again?”
While Kathy and Lynda teach the fourth class, Laurent, Cassidy and I sit with – I’ll call him “Andre” – in the only quiet, moderately private spot we can find: our vehicle.
Andre says that he has great difficulty falling asleep, and when he finally does, nightmares always come. “I feel so helpless. I cannot talk to anyone.” He grabs his throat with every other sentence. When I mention the gesture, he tells me that his “words are stuck in my throat. And I am afraid to cry. It is not manly.”
Andre tells us that on January 12th, he was supposed to pick up “my cousins who I love very much, at the University.” He called to them that he couldn’t. They stayed late, and died when the building collapsed.
These cousins, “my best friends,” lived with him and were more like sisters—“one light skinned, one dark,” he smiles with the memory. “I feel so guilty. I want to go back to the time and save them, but it is not possible. I have concluded,” he lowers his voice here, “I do not want to be left behind.”
I recognize the self-annihilating weight of this guilt, have seen it burden young and old in Kosovo, Israel, Gaza, have heard how it torments the nights of soldiers and marines returning from Iraq and Afghanistan.
“Would you,” I ask him, “be willing to meet your cousins in your imagination to talk with them and ask for their advice?”
“I have them always in my heart, but when I talk with them, it makes me cry.”
I tell him that he needs to cry—that releasing his emotions will open his throat, that perhaps his cousins have something to say to him that will help him with his guilt. He nods in agreement.
I ask him to close his eyes and breathe deeply with his belly soft, as we did in class. “Imagine that you are in a safe and comfortable place—a place where you feel good.” He does and I ask him to imagine that his cousins are there with him.
“Would you be willing,” I say, “to ask them for their advice?”
He nods his head.
After a while, his face softens and small tears appear at the outer edge of his eyes.
“Did they come?” I ask.
“Yes.”
“What was it like? What did they say?”
“I was so happy to see them. They told me to keep living my life and that I was not responsible for their death.”
“Write it down,” I say to him, after he has opened his eyes “and look at it every day. “Keep living your life. You are not responsible.”
I notice that he is breathing more deeply and no longer clutching at his throat.
Making our way back to the classroom, I feel how urgent it is to train hundreds of people to do this tender, powerful, necessary work.
We’ve just returned from our visit to Haiti today. I look forward to taking a look at what you’ve got to say on this and other posts from Haiti soon.
Meetings with Remarkable Haitians—Dr. Jean Hugues Henrys and Dr. Alex Larsen
Our last full day in Haiti brought us another unexpected and auspicious meeting. On our first visit to Haiti the month before, Rosemary and I had met with Dr. Claude Surena, an internist who is head of the Haitian Medical Association and principal advisor to the Ministry of Health. Dr. Surena was extremely enthusiastic about working with us. This time Dr. Surena was out of the country, and he suggested we meet with his colleague, Dr Jean Hugues Henrys.
The problem was that we could no more find Dr. Henrys — housed in temporary quarters and mostly out working in the clinics and hospitals — than we could Drs. Guiteau and Amedee-Gedeon. Lee-Ann called and called, and finally—“just one more time.” We reached him, and set an appointment for the last hour of our last day in Port-au-Prince.
It turned out Dr. Henrys, a genial host, was as happy to see us as we him, and was particularly eager for us to work with Ministry of Health employees. Their building had been destroyed, many of their colleagues were dead, and the ones who remained were carrying grief for lost friends as they dealt with the enormous needs of the population.
And then, as the meeting was winding down, another man entered the room. It turned out to be the Minister of Health, Dr. Alex Larsen. Dr. Henrys filled him in on our work and what we had been talking about and went on to make a suggestion. “It says in your proposal,” Dr. Henrys–a quick study– reminded us, “that you want to have a ‘Haitian leadership team.’ It is important that you work with the future leaders too, with medical students, and others concerned with the social sciences.”
“Yes,” I say, “we do that in the US. That would make me very happy.”
“Perhaps he has not told you,” Dr. Larsen interjected, smiling, “but Dr. Henrys is the Dean of our Medical School.”
Next post: the very successful workshop we offered to American Red Cross workers during our visit.
Meetings with Remarkable Haitians: Drs. Guiteau & Amedee-Gedeon
One of the sure but less obvious signs that our work is going well, and that it is meant to go well, is the increased incidence of synchronistic experiences– of happy, unexpected, unpredictable coincidences –that forward what we are doing.
These events don’t arise without effort; in fact, they often come only after we have worked very hard, and when the desired result — in this case, meetings with key figures in Haitian healthcare — seems altogether unattainable. We had two such unexpected happy events – meeting with four more remarkable people on the last two days of our visit.
On our fourth day, April 9th, I led a workshop for American Red Cross staff — it went very well, and I’ll tell you about it later. For some days prior to it, however, we had tried unsuccessfully—by phone and email—to reach the leadership of the Haitian Red Cross, an organization that is central not only to emergency recovery, but to providing long-term services and education to the Haitian population. Everyone wanted to help but nothing seemed to work. We encountered unanswered phones, voicemail messages that languished, outdated e-mail addresses. We did hear that the Red Cross leaders were busy developing and supervising projects all over Port-au-Prince so we thought we might be able to follow leaders and track them down.
As we drove from one destroyed neighborhood to another, I remembered these “personal searches” were what we’d done in Kosovo after the war when the land lines weren’t functioning and cell phones were rare. Finally, hot and seat-sore from riding over Port-au-Prince’s pothole-punctuated, rubble-strewn roads, we accepted what seemed inevitable: we would have to wait till next trip to meet the Haitian Red Cross leadership.
An example of Haitian streets
However, since it wasn’t yet dark, I—ever optimistic– thought we might pay a visit to the University of Miami Medishare hospital, where I had spent so much time on my first visit to Haiti. It turned out we couldn’t find that either.
“Maybe,” our driver opined, “someone at the Red Cross installation nearby”—he gestured to one we had not yet visited—“would know where it is.”
“Okay,” I thought as we arrived, “let’s ask about Medishare. But let’s also try just once more to see if anyone knows where we can find the Red Cross president, Dr. Michael Amedee-Gedeon and Dr. Jean-Pierre Guiteau, the Executive Officer.
When I mentioned their names, the guard looked uncomprehending. Still, I handed him my card. Ten minutes later he returned with instructions to bring us ahead. As we walked over the crushed stone toward a newly constructed building, a man as puzzled to see us as we would be surprised and delighted to see him, approached.
He was, it turned out, Dr. Guiteau, a long-time leader in public health with a particular expertise in and concern for Haiti’s children. Still a bit puzzled but exceedingly gracious, he invited us to the conference room and offered us coffee. Soon we were soon joined by Dr. Amedee-Gedeon, who made us feel as if we were not only most welcome but long expected. She said she specialized in nutrition, as well as public health. She had previously been, Dr. Guiteau told us, Haiti’s Health Minister.
I described our work, stumbling a little at first even in English, because I was still amazed that we were actually talking with them. When I finished, they asked a few questions about the length and scope of our training and the research we had done on our work with professionals and with traumatized kids. They told us how concerned they were about the stress their staff and volunteers were experiencing—“So many have lost family and friends themselves.” They appreciated that the skills that we had to teach could be helpful to these burdened men and women as well as to their many thousands of “beneficiaries.” They were particularly interested, given our experiences in Kosovo and Gaza, in how we might help the large number of amputees whom, they feared, “would never live up to their potential.”
Next post: Meet the Minister of Health Dr. Alex Larsen, and Dr. Jean-Hugues Henrys
Meetings with Remarkable Haitians: Dr. Emmanuel Justima
Dr. Emmanuel Justima
I originally met Justima (it’s his last name; as he said, he likes to be called that to distinguish him from “other Emmanuels”) at a “psychosocial cluster” meeting to which Lee-Ann and I had been invited. Perhaps 30 nongovernmental organizations (NGOs) were present. All are working with “psychosocial” issues: the emotional challenges, psychological, and social needs of the close to 2 million people who have lost family members and/or been displaced by the earthquake.
Justima, tall, broad shouldered, slim, in black pants and a crisp checked shirt, entered the room halfway through the meeting and shook hands with the UN coordinators. He stood tall and at ease at the front. When his turn came, he spoke in a voice loud and clear enough that even I– aurally challenged, and still scrambling to recover my French–could understand. And just in case I or anyone else had missed his meticulous instructions on prompt program registration with the Haiti Ministry of Health, he repeated it in flawless English.
Afterwards, Justima began our hour-long private meeting by announcing that PNI (psychoneuroimmunology– the scientific foundation of mind-body medicine), was his “passion as well as [my] professional field of expertise.” For a moment I thought he was putting me on. Another Emmanuel (last name Streel), the psychologist who coordinates the NGO psychosocial programs, had just told me about his own interest in mind-body medicine. “Vraiment?” (“Really?”) I said to Justima in my best, quizzical French.
“Yes,” he replied. “And, of course, we have to teach people to help themselves. There are only 10 psychiatrists in all of Haiti, and not many more psychologists.”
It has long been clear to me, after work with many other traumatized populations, that self-care and mutual help are logical centerpieces of a population-wide mental health program. But how surprising, and how wonderful, that someone so central to the Haitian mental health plan not only welcomes our way of working, but is steeped in the science that supports it.
Justima sits across from me at a narrow table in a prefab corrugated metal UN building, flanked by internationals concerned with similar issues. He takes care of business carefully but briskly, reminding us again of registration requirements, offering to find the most competent translators to put our materials into French and Creole. He carefully repeats phrases I don’t understand.
Around his mouth and in Justima’s eyes, amidst striking efficiency and intelligence, I see the smile of a man who, with all the weight the world has put on him, still enjoys life. I look forward to working with him, and to spending more time with him.
I regret that we didn’t get any pics of Justima. More pics next installment, when we meet Drs. Guiteau & Amedee-Gedeon of the Haitian Red Cross . . .
Meetings with Remarkable Haitians: Pierre Andre DuMas
Haiti is often criticized, even derided for its lack of leadership, or alternately or in addition, for the corruption and cruelty of its leaders. And there is, no question, a long legacy, during and after slavery, of oppression; and of political, social, economic, and spiritual hopes raised and devastatingly betrayed.
On the other hand — and there is definitely another hand — the Haitian people are blessed, at least within the fields I’m coming to know best (medicine, mental health, and public health) by a leadership group that is knowledgeable, thoughtful, and skillful, as deeply committed to the welfare of its people and as open-minded as any I’ve found anywhere in the world. These Haitian leaders seem at this crucial moment in history far less encumbered with the self-importance and pride that afflicts many national and, indeed, professional leaders I have known. Their commitment to the welfare of their people and their compassion trump received truths and narrow professional prerogatives.
Here’s a pic of Haiti streets finally looking a little more alive:
Already you’ve met two of these remarkable people: Alix Lassegue, the physician who directs the University Hospital, and Marlaine Thompson, the nurse who works closely with him. Together, they embrace the flood of people who overwhelm the hospital. They shape the comprehensive services for the complex problems that their patients, overwhelmed by the earthquake as well as the ordinary calamities of Port-au-Prince daily life, bring to them. In the next few blog entries I’ll introduce you to several other of these remarkable men and women, the welcoming leaders and kind teachers with whom we hope to be working closely in the months and years ahead.
Monseigneur Pierre Andre DuMas
There are certain people, who upon entering a room, fill and light it up. Monseigneur Pierre Andre Dumas, bishop of the Diocese Anse-a-veau/Miragoane and president of the Catholic Church’s service arm, Caritas, and Dr. Emmanuel Justima, a psychologist who is a leader in shaping the Haitian national mental health plan (whom you’ll meet next installment) are two.
Pierre Andre DuMas is tall, supple, gray-haired, and dressed in gray vestments. Sitting with him I feel myself warmed by his abundant energy and his generous sweet nature. Though I have never met him before, I somehow feel that I know him. Like my old close friends, we simply share what is most important to us, find ourselves embellishing each others’ narratives, and quickly invite each other into our unfolding lives.
I tell Pierre Andre a little bit about our work and where we have done it, and he smiles with recognition. He invites me to present our way of healing trauma to Haiti’s religious leaders, “as soon as we can arrange it.” It is part of his job, he tells us, to bring together Protestants as well as Catholics, Jews, Muslims and Voudoun practitioners.
He tells us about the thousands who have returned from Port-au-Prince to his rural diocese and the dislocation and suffering they bring with them. On Good Friday, he hiked up a nearby mountain with 6000 people from his diocese. “We sat by a waterfall and breathed deeply, relaxed — Like your work, no? Some of us swam. All of us needed a catharsis.”
When I give him a copy of my book Unstuck, I assure him that he will enjoy it even though he’s not depressed. “I know that you know that I am not,” he says. “If you are still alive,” he adds, opening his hands, “you have to stand up and give hope.”
Next installment, meet Emmanuel Justima, a psychologist working on Haiti’s National Mental Health Plan
